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With roughly 24 million chronic obstructive pulmonary disease (COPD) patients in the United States, COPD care demands incredible spending—nearly $36 billion a year.1 Yet as healthcare evolves, COPD care teams are facing another incredible demand—increasing the quality of care while lowering the cost of it. This leaves organizations searching for new solutions to these newfound problems.

So what can your team do to combat increasing costs without sacrificing quality care for COPD patients? Joining an ACO may be the solution.

What is an ACO?

An ACO, or accountable care organization, is a group of multidisciplinary healthcare professionals who work together to coordinate care for Medicare patients. Their purpose is to improve quality and reduce costs.2

An ACO can comprise hospital physicians, nurses, home healthcare workers, private-practice physicians, insurance companies, laboratorians, and more. This dedicated team is responsible for a patient’s entire continuum of care, providing a longitudinal approach rather than episodic. This approach works to proactively keep patients healthy, at home, and out of the hospital.

By working together and coordinating efforts, ACOs enable institutions to better predict, analyze, target, and treat entire populations.

Les Duncan

Director of Operations, Highmark-
Community and Health Services

On positively impacting patients and institutions

The ACO model is so important because people with chronic disease should be living well in their homes, they shouldn’t be accessing hospital services, which is the most expensive component of healthcare.”

How do ACOs work?

ACOs are different from HMOs, or health maintenance organizations, in that patients can visit any healthcare facility, whether or not it is part of the ACO. However, all organizations within the ACO are still accountable for that patient’s wellbeing.

As such, keeping track of each patient’s care is crucial to the success of an ACO. Medicare helps by:

• Assigning all patients a unique tax identification number

• Tracking numbers to know when patients submit claims

• Reporting claims data back to the ACO

Since many ACOs are responsible for tens of thousands of patients, tracking these ID numbers streamlines monitoring and care management.

The main benefits of an ACO

On making the most of the ACO opportunity

—Les Duncan, Director of Operations

Highmark–Community and Health Services

ACOs—maximizing value in COPD care

Not only are ACOs proving to be valuable for the healthcare industry as a whole, they are creating vital advantages in managing COPD. See how our thought leaders are breaking down the benefits across the care journey.

Earlier identification

As ACOs support broader datasets across populations, they can be a huge driver in identifying patients earlier. This empowers more effective care. For different individuals, it can mean better maintenance of wellness or management of chronic disease. But for all patients, it can help contain costs down the road.

On the benefits of ACO data and analytics

—Les Duncan, Director of Operations

Highmark–Community and Health Services

Stratifying patients by risk

Once patients are identified, ACOs give physicians the ability to stratify them by risk and implement best practices accordingly.

End-stage disease patients: The largest cost when treating COPD patients comes in the last year of life. Patients are often in and out of hospitals and don’t have an end-of-life plan established with their caregivers. Spending in this tier can exceed $59,000 (median) annually per patient.3

ACOs are designed to proactively maintain health, thereby avoiding (or delaying) deterioration to end-stage disease. This supports healthy outcomes for patients and the institutions responsible for their care.

Chronically ill patients: According to a 2014 study by the Centers for Disease Control (CDC), a COPD patient is $6,000 more expensive than a non-COPD patient. And, the cost of readmission is on average 1.5 to 1.75 times the cost of regular admission, plus Centers for Medicare & Medicaid Services (CMS) penalties. For chronically ill patients alone, these admissions multiply the cost of care. In addition, each exacerbation can further decrease lung function, adding more cause for spending.

ACOs are designed to focus on quality, so savings inevitably follow. They are generally associated with establishing nurse care coordinators, setting up home care plans, engaging patients in self-management, and ensuring patients have a home support system to help manage their condition. This adds up to optimal care at every touch point and can be the keystone to getting ahead of exacerbations and costly admissions.

Generally healthy patients: Although the bottom tier of the pyramid is the least expensive, this population of patients should not be ignored. They are seemingly healthy now, yet could have underlying issues or risk factors for conditions that will present later in life.

Yet because these patients have no or few apparent issues, they often don’t seek medical attention. These people may be heading toward threatening, costly health issues, unknown to anyone. Hence, they are often termed the “silent third.”

To address this, ACOs cover the cost of yearly wellness visits for all patients. Wellness visits are an opportunity for patients to sit down with their primary care physician (PCP) and discuss their overall health and wellbeing, giving their PCP the ability to intervene and manage issues before they occur. This represents ACO quality at its finest.

On the value of patient stratification

—Les Duncan, Director of Operations

On the vision of preventative care

We want a more proactive approach in population health management. We need to get to a point where we invest more in preventative and well care so we are avoiding the index admissions”

—Becky Anderson, RRT

Respiratory Care Services Sanford Medical Center

Get them home, keep them home

COPD care teams can no longer afford to only focus on getting patients healthy and home. They now need to ensure patients stay well enough to avoid coming back. This requires more than coordination. It requires a major investment in home healthcare, which is perfectly in line with the ACO model.

According to Les Duncan, 50% of the cost of an ACO is inpatient admissions and 25% is post-acute care. This post-acute care includes skilled nursing facilities, home health, and inpatient rehab facilities. In an ACO setting, you want to see this high grade of spending in post-acute care, as it is a big-picture investment in reducing the risk of far costlier admissions.

The data collected through an ACO can help you determine the most efficient place and time to provide care.

• Home contact:Whether a care manager, nurse, or other care team member, this intermediary support network can work with patients to de-escalate problems, help them learn to self-manage at home, and avoid going to the emergency department (ED)

• Extended team: Increasing your investment in social workers, nurse care coordinators, and respiratory therapists within your ACO can help minimize the cost burden of hospital visits and provide patients with the care they need in the home setting

On the cost savings of post-acute care

—Les Duncan, Director of Operations

Highmark–Community and Health Services

On reducing ED visits with care managers

—Les Duncan, Director of Operations

Highmark–Community and Health Services

ACOs and you

They say teamwork makes the dream work—and this certainly applies with ACOs. So, as you evaluate your COPD treatment goals, consider this: How could an ACO be beneficial to your institution and patients?

Further reading

COPD insider

Insider guide: Building your COPD executive care team

This infographic details how to build your multidisciplinary executive care team and what contribution you can expect from each team member.

Identifying COPD patients: The first step to quality outcomes

Learn how to identify patients with COPD sooner by proactively focusing on additional risk factors, special populations, and more.

How ACOs align perfectly with COPD treatment goals

What exactly is an ACO and how can it impact your practice? Get ready for a very moving discussion on how itzlready redefining value-based care.

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